Infecciones del sistema nervioso central asociadas a dispositivos de derivación de LCR en niños, en un centro neuro-quirúrgico de referencia nacional / Central nervous system infections associated with CSF shunt devices in children, at a national reference hospital

INTRODUCCIÓN: Las infecciones asociadas a dispositivos de derivación de LCR son una complicación frecuente en su utilización. Lo más habitual es la presencia de cocáceas grampositivas, como Staphylococcus coagulasa negativa (50% en algunas series) y Staphylococcus aureus. Esta complicación agrega morbimortalidad al paciente neuroquirúrgico, aumentando la estadía hospitalaria y los costos de tratamiento. OBJETIVO: Conocer la incidencia de infecciones asociadas a dispositivos de derivación de LCR en un centro de referencia nacional. METODOLOGÍA: Estudio descriptivo, retrospectivo. Se recolectó la información de los pacientes pediátricos (bajo 18 años) entre 2018 y 2019. Se realizó un análisis estadístico descriptivo e inferencial utilizando el lenguaje estadístico R 3.4.0 y RStudio 1.3.9. Se calculó la incidencia acumulada para cada procedimiento, evaluando si existe diferencias significativas entre ellas. Estudio aprobado por el Comité de Ética Pediátrico del SSMO. RESULTADOS: En el período estudiado se realizaron 175 cirugías. Encontramos 19 casos de ventriculitis asociada a derivativa ventriculo-peritoneal y 7 casos en derivativa ventricular-externa. Los agentes más frecuentes fueron las cocáceas grampositivas. No se logró identificar factores de riesgo significativos.

BACKGROUND: Infections associated with CSF shunt devices are a frequent complication in their use. The most common is the presence of gram positive coccaceae, such as coagulase negative Staphylococcus (50% in some series) and Staphylococcus aureus. This complication adds morbidity and mortality to the neurosurgical patient, increasing hospital stay and treatment costs. AIM: To determine the incidence of infections associated with CSF shunt devices in a national referral center. METHODS: Retrospective, descriptive study. Information was collected on pediatric patients between 2018 and 2019. A descriptive and inferential statistical analysis was performed using the statistical language R 3.4.0 and RStudio 1.3.9. The cumulative incidence for each procedure was calculated, evaluating whether there were significant differences between them. This study was approved by the Pediatric Ethics Committee of the SSMO. RESULTS: In the period studied, 175 surgeries were performed. We found 19 cases of ventriculitis associated with ventriculoperitoneal derivative and 7 cases in ventricular-external derivative. The most frequent agents were grampositive coccaceae. It was not possible to identify significant risk factors.

[Ventriculo-gallbladder shunt: An alternative for the treatment of hydrocephalus]. / Derivación ventrículo-vesicular: una alternativa en el tratamiento de hidrocefalia.

BACKGROUND: In the management of hydrocephalus, the ventriculo-gallbladder shunt is justified in situations where the ventriculo-peritoneal shunt is not useful due to peritoneal involvement and/or when the ventriculo-auricular and ventriculo-pleural shunts are contraindicated. CLINICAL CASE: A 27 year-old female with hydrocephalus at birth, managed with ventricle-peritoneal shunt, modified 3 times throughout her life due to repeated infections and other different reasons. She was admitted due to colitis caused by Clostridium difficile, presenting concomitant signs of intracranial hypertension and neurological impairment. This led to a review and change of the ventriculo-peritoneal shunt system, with distal dysfunction due to peritoneal thickening. Atrial and pleural shunts were not indicated because the risk of infection. As an alternative, it was decided to place the distal end of the catheter in the gallbladder. The patient recovered her neurological functions after the surgery. CONCLUSIONS: Drainage alternatives may be needed in 5% of patients with valvular shunt dysfunction. The ventriculo-gallbladder is a good and viable option because it has an absorptive capacity of 1500cc liquid daily, besides being an excellent drainage through the bile duct. The abdominal surgery is easy to perform, and it is an alternative option in the failure of the ventriculo-peritoneal shunt.

[Clinical scale for the diagnosis of ventriculoperitoneal shunt malfunction in children in Emergency Department]. / Escala clínica para el diagnóstico de disfunción de válvula ventriculoperitoneal en niños en el Servicio de Urgencias.

INTRODUCTION: It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or enough specific enough to diagnose the shunt malfunction. OBJECTIVE: To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. MATERIAL AND METHODS: This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. RESULTS: A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age>4 years, vomiting, recent neurological deficit, and time since last surgery ≤ 2 years) with a maximum score of 20 points. It was found that Scale scores ≥ 7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4-74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). DISCUSSION: A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well the usual radiation suffered by these children.

Migración intracraneal de derivativa ventrículoperitoneal en paciente con hidranencefalia: reporte de un caso / Intracraneal migration of ventriculoperitoneal shunt in a patient with hydranecephaly: case report

La migración intracraneal de una derivativa ventrículo peritoneal (DVP) es una rara causa de disfunción valvular. Se presenta el caso de un paciente portador de hidranencefalia congénita con DVP desde el mes de vida, quien fue referido a neurocirugía a la edad de dos años y un mes por somnolencia, vómitos y bradicardia. El estudio con TC de encéfalo y radiografía de trayecto valvular revelaron migración intracraneal de su sistema derivativo, por lo que requirió cirugía de urgencia para retiro del sistema y reemplazo valvular. Inmediatamente posterior a la cirugía el paciente tuvo remisión completa de sus síntomas. A continuación se discuten los posibles mecanismos involucrados en su génesis y las medidas para evitar esta complicación

Intracranial migration of ventriculoperitoneal shunt is an extremely rare complication of hydrocephalus surgery. We present the case of a patient with congenital hydranencephaly treated with ventriculoperitoneal shunt installed elsewhere in the first month of life. He was referred to our center when he was 2 years old. The consulting symptoms were somnolency, vomiting and bradycardia. The image study consisted in a brain CT and chest x-ray that revealed the intracranial migration of his ventriculoperitoneal shunt. The patient was operated with the remotion of his shunting system and a complete new ventriculoperitoneal shunt was installed. Inmediately after surgery the patient had a complete remission of his symptoms. We reviewed the case due to the unusual of the complication and we discussed the possible mechanisms involved in its genesis and the measures to avoid it.

Endocarditis infecciosa: experiencia quirúrgica en el Cardiocentro de Santiago de Cuba / Infectious endocarditis: surgical experience at the Cardiology Center of Santiago de Cuba

Se realizó un estudio epidemiológico, descriptivo y transversal, de 104 pacientes intervenidos en el Cardiocentro del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora de Santiago de Cuba, desde enero de 1988 hasta diciembre del 2008, por presentar endocarditis infecciosa. Entre los hallazgos sobresalió el predominio del grupo etario de 15-45 años, del sexo masculino, de la cardiopatía reumática como factor predisponerte, de la forma de presentación séptico-infecciosa, de los estafilococos como gérmenes y de los hemocultivos negativos. La disfunción valvular fue la principal indicación quirúrgica, seguida de la insuficiencia cardíaca. La mortalidad representó 16,3 por ciento, atribuible fundamentalmente al fallo multiorgánico por sepsis y al bajo gasto cardiaco. Los resultados de estas operaciones son buenos en la mencionada institución(AU)

A descriptive cross-sectional and epidemiological study was carried out in 104 patients operated due to infectious endocarditis at the Cardiology Center of the Saturnino Lora Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba from January 1988 to December 2008. Among the findings was the prevalence of the 15-45 year-old patients, male sex, rheumatic heart disease as predisposing factor, and septic and infectious presentation, staphylococci as pathogens and negative blood cultures. Valve disease was the main surgical indication followed by heart failure. The mortality was 16,3 percent attributable mainly to multiorgan failure due to sepsis and to the low cardiac output. The results of these interventions are favorable in that institution(AU)

Endocarditis infecciosa: experiencia quirúrgica en el Cardiocentro de Santiago de Cuba / Infectious endocarditis: surgical experience at the Cardiology Center of Santiago de Cuba

Se realizó un estudio epidemiológico, descriptivo y transversal, de 104 pacientes intervenidos en el Cardiocentro del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora de Santiago de Cuba, desde enero de 1988 hasta diciembre del 2008, por presentar endocarditis infecciosa. Entre los hallazgos sobresalió el predominio del grupo etario de 15-45 años, del sexo masculino, de la cardiopatía reumática como factor predisponerte, de la forma de presentación séptico-infecciosa, de los estafilococos como gérmenes y de los hemocultivos negativos. La disfunción valvular fue la principal indicación quirúrgica, seguida de la insuficiencia cardíaca. La mortalidad representó 16,3 por ciento, atribuible fundamentalmente al fallo multiorgánico por sepsis y al bajo gasto cardiaco. Los resultados de estas operaciones son buenos en la mencionada institución.

A descriptive cross-sectional and epidemiological study was carried out in 104 patients operated due to infectious endocarditis at the Cardiology Center of the Saturnino Lora Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba from January 1988 to December 2008. Among the findings was the prevalence of the 15-45 year-old patients, male sex, rheumatic heart disease as predisposing factor, and septic and infectious presentation, staphylococci as pathogens and negative blood cultures. Valve disease was the main surgical indication followed by heart failure. The mortality was 16,3 percent attributable mainly to multiorgan failure due to sepsis and to the low cardiac output. The results of these interventions are favorable in that institution.